title: Clinical review of 37 patients with medullary infarction.
abstract: BACKGROUND
  Clinical features of medullary infarction were compared between patients with lateral medullary infarction and medial medullary infarction
  
  
  METHODS
  Thirty-seven patients with medullary infarction (29 with lateral medullary infarction and 8 with medial medullary infarction) who were admitted to our center between April 1, 2007 and March 31, 2010 were examined. Background factors, neurologic signs and symptoms, imaging findings, cause of disease, and outcomes were assessed for patients with lateral and those with medial medullary infarction.
  
  
  RESULTS
  Examination of the clinical symptoms and neurologic findings suggested that among patients with medial medullary infarction, few demonstrated all of the symptoms of Dejerine syndrome at onset, and many had lesions that were difficult to locate based only on neurologic findings. Both lateral and medial medullary infarction were frequently caused by atherothrombosis. However, cerebral artery dissection was observed in 31% of patients with lateral medullary infarction and 12.5% of those with medial medullary infarction. In 13% of patients with lateral and 37% of patients with medial medullary infarction, magnetic resonance imaging diffusion-weighted images on the day of onset did not show abnormalities, and the second set of diffusion-weighted images confirmed infarction lesions. For lateral medullary infarction, a more rostral lesion location was correlated with a poorer 90-day outcome. For medial medullary infarction, a more dorsal lesion location was correlated with a poorer 90-day outcome.
  
  
  CONCLUSIONS
  The diagnosis rate of medullary infarction using imaging examinations at onset--particularly medial medullary infarction--is not necessarily high. The imaging examinations need to be repeated for patients who are suspected to have medullary infarction based on neurologic signs and symptoms.
authors.affiliation: Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Saitama, Japan. tfukuoka@saitama-med.ac.jp
authors.forename: Takuya
authors.initials: T
authors.lastname: Fukuoka
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Takeda
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Dembo
authors.forename: Harumitu
authors.initials: H
authors.lastname: Nagoya
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kato
authors.forename: Ichiro
authors.initials: I
authors.lastname: Deguchi
authors.forename: Hajime
authors.initials: H
authors.lastname: Maruyama
authors.forename: Yohsuke
authors.initials: Y
authors.lastname: Horiuchi
authors.forename: Akira
authors.initials: A
authors.lastname: Uchino
authors.forename: Susumu
authors.initials: S
authors.lastname: Yamazaki
authors.forename: Norio
authors.initials: N
authors.lastname: Tanahashi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020526:Brain Stem Infarctions / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D002533:Cerebral Angiography; D016009:Chi-Square Distribution; D003952:Diagnostic Imaging / Q000379:methods; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D014854:Lateral Medullary Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D055815:Young Adult